Radiotherapy increases plasma levels of tumoral cell-free DNA in non-small cell lung cancer patients

// Shun-ichiro Kageyama 1 , Keiji Nihei 1 , Katsuyuki Karasawa 1 , Takeshi Sawada 1 , Fumiaki Koizumi 1 , Shigeo Yamaguchi 1 , Shunsuke Kato 1 , Hidehiro Hojo 1 , Atsuhi Motegi 1 , Katsuya Tsuchihara 1 and Tetsuo Akimoto 1 1 National Cancer Center Hospital East, Kashiwa, Chiba 277-8577, Japan Correspondence to: Shun-ichiro Kageyama, email: skageyam@east.ncc.go.jp Keywords: tumoral cell-free DNA; radiotherapy; NSCLC; tumor-specific mutations; digital PCR Received: November 21, 2017      Accepted: March 21, 2018      Published: April 10, 2018 ABSTRACT We investigated the plasma levels of tumor-specific cell-free DNA (cfDNA) in 17 stage I–II (early) and IV (advanced) non-small cell lung cancer (NSCLC) patients who underwent radiotherapy. Digital polymerase chain reaction (PCR) and targeted sequencing showed that total and tumor-specific cfDNA levels increased in response to radiotherapy in both early- and advanced-stage NSCLC patients. We detected high copy numbers of epidermal growth factor receptor mutations (L858R and T790M) in the cfDNA samples from stage IV NSCLC patients who underwent stereotactic body radiation therapy to treat brain metastasis related to tyrosine kinase inhibitor (TKI) treatment failure. In conclusion, our study demonstrates that radiotherapy increases tumoral cfDNA levels in the plasma and shows potential to serve as an indicator for diagnosing drug-resistant tumor-related gene mutations in early-stage NSCLC patients or those undergoing molecular targeted therapy.